Registration: Tend Thy Friend, providing pastoral care in all kinds of weather (May 12, 2017 - May 14, 2017 )

USER INFORMATION
First Name:
Last Name:
Address:
1
City:
State:
Zip:
Email:
Phone:
Would you like to be included on the carpool list? The list is sent to people who are on it.:
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Check any of these restrictions that apply (you may explain details in the next box):
vegetarianveganallergy-specify belowno gluten
Explain any specific food needs or things that the cook should know:
1
Your Quaker meeting or other faith community:
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Note any concerns we should be aware of (health, accesibility, etc.):
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Enter the amount of financial aid you are requesting from Powell House:
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The following information I have given here is new:
mailing addressphone numbere-mailfood needs
Please note here anything else we should know.:
The deposit amount will appear automatically on the confirmation page. You may change the amount by typing in what you want to pay at this time (above the minumum deposit).

Powell House is the conference and retreat center of the 

New York Yearly Meeting of the Religious Society of Friends (Quakers).

Powell House
524 Pitt Hall Rd
Old Chatham,  NY
12136
phone  518-794-8811
fax     518-794-8815
Adult Program 
sharon@powellhouse.org
regina@powellhouse.org
Youth Program
chrisandmike@powellhouse.org